Ultimately, in elderly patients presenting with AUR and fever of an unclear etiology, rapid decompression of the bladder through catheterization should be achieved.¹⁰ Afterward, the patient’s medication list—including the use of over-the-counter medications such as NSAIDs—should be carefully reviewed for signs of any causative agents.^2,10

In the case described, a postvoid residual ultrasound showed that the patient was retaining approximately 700 mL of urine. His bladder was successfully drained with the placement of a urethral catheter, and a UA showed him to have significant bacteriuria. Due to the possibility of acute prostatitis, a digital rectal exam was deferred. Ultrasound imaging showed evidence of a heterogeneous, inflamed prostate, and the patient was diagnosed with acute prostatitis. While the urine culture was pending, the patient was empirically started on a broad-spectrum intravenous antibiotic and admitted to the hospital, where he rapidly improved. 48 hours later, the patient’s urine culture grew E. coli colonies, sensitive to trimethoprim/sulfamethoxazole. The patient was discharged on a four-week course of oral antibiotics, and followed up in clinic for repeat urine cultures. Ultimately, the patient made a full recovery.

Dr. Turner is an emergency medicine intern at Hershey Medical Center in Hershey, PA.

Dr. Marco is professor of emergency medicine at Penn State Health-Milton S. Hershey Medical Center and associate editor of ACEP Now.

References

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